A review of the safety and efficacy of nebivolol in the mildly hypertensive patient

Abstract

Nebivolol is a third generation beta-blocker, which can be distinguished from other beta-blockers by its hemodynamic profile. It combines beta-adrenergic blocking activity with a vasodilating effect mediated by the endothelial L-arginine nitric oxide (NO) pathway. The effects of nebivolol have been compared with other beta-blockers and also with other classes of antihypertensive agents. In general, response rates to treatment are higher, and the frequency and severity of adverse events are either comparable or lower with nebivolol. Nebivolol is also effective in reducing cardiovascular morbidity and mortality in elderly patients with heart failure, regardless of the initial ejection fraction. Endothelium-derived NO is important in the regulation of large arterial stiffness, which in turn is a major risk factor for cardiovascular disease. Treatment with nebivolol increases the release of NO from the endothelium and improves endothelial function, leading to a reduction in arterial stiffness. Decreased arterial stiffness has beneficial hemodynamic effects including reductions in central aortic blood pressure. Unlike first generation beta-blockerrs, vasodilator beta-blockerrs such as nebivolol have favorable hemodynamic effects, which may translate into improved cardiovascular outcomes in patients with hypertension.

Figure 1

Pathophysiological pathways through which aortic stiffness may contribute to the development of diastolic dysfunction. DBP, diastolic blood pressure; SBP, systolic blood pressure. Reproduced with permission from Mottram PM, Haluska BA, Leano R et al 2005. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart, 91:1551–6. Copyright © 2005. BMJ Publishing Group Ltd.

Figure 2

Time to first occurrence of events (all cause death or hospital admission for a cardiovascular reason – primary endpoint). Flather MD, Shibata MC, Coats AJ et al 2005. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J, 26:215–25. Copyright © 2005. Oxford University Press.